Photoselective KTP laser vaporization of the prostate: First experiences with 65 procedures

Purpose: To study the feasibility and efficacy of 80 W potassium-titanyl-phosphate (KTP) laser vaporization (GreenLight PV; Laserscope((R))) of the prostate in patients suffering from voiding dysfunction secondary to benign prostatic hyperplasia (BPH) or known locally advanced prostate cancer (CaP). Patients and Methods: Sixty-five patients with symptomatic BPH (N = 57) or obstructive voiding secondary to CaP (N = 8) with a mean age of 70 +/- 10 years (range 46-93 years) underwent photoselective 80 W KTP laser vaporization of the prostate. All consecutive patients, including 34 with a history of chronic urinary retention or indwelling catheter, were enrolled. Prostate specific antigen (PSA) values, prostate volume as measured by transrectal ultrasonography, urinary peak flow measurement (Q(max)), postvoiding residual volume (PVR) measured transvesically, and International Prostate Symptom Score (IPSS) were assessed preoperatively, on the day of discharge, and 1 month and 3 months postoperatively. The mean preoperative prostate volume was 49 +/- 32 cc (range 15-250 cc). Results: In all 65 patients, KTP laser vaporization was performed successfully, with a mean operating time of 57 +/- 25 minutes (range 10-160 minutes). No major complication occurred intraoperatively or postoperatively, and no transfusions were necessary. All patients were catheter free after 1 month. At 1 month and 3 months, the urinary peak flow had increased from 7.7 +/- 2.8 mL/sec preoperatively to 20.9 +/- 11.6 mL/sec (+171%) and 18.2 +/- 6.3 mL/sec (+136%), respectively. The IPSS decreased from 18.5 +/- 6.7 to 9.2 +/- 7.7 (-50%) and 7.2 +/- 5.9 (-61%) at 1 and 3 months, respectively. Conclusions: A 80 W KTP laser vaporization of the prostate technique instantly removes obstructive tissue. A transurethral resection-like visible cavity is the endpoint. Immediate symptom relief is achieved in a truly minimally invasive way with a very low postoperative complication rate within 3 months' follow-up.